A Prospective and Randomized Study for Improvement of Acute Asthma by Non-invasive Positive Pressure Ventilation (NPPV)

Soma, Tomoyuki; Hino, Mitsunori; Kida, Kenji; Kudoh, Shoji

doi:10.2169/internalmedicine.47.0429

Cited by 90 publications

(62 citation statements)

References 36 publications

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“…The first study 62 showed improved flow and fewer hospitalizations with NIV, versus sham NIV. The second study 63 reported similar conclusions with high inflation pressure, but not with low pressure or with standard medical therapy. In patients with severe acute asthma, the addition of NIV to standard therapy probably accelerates the improvement in lung function, decreases the inhaled bronchodilator requirement, and shortens the stay in the ICU.…”

Section: Asthmamentioning

confidence: 65%

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Nava

2013

Respir Care

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It is difficult to exactly date the beginning of mechanical ventilation, but there are no doubts that noninvasive ventilation (NIV) was the first method of ventilatory support in clinical practice. The technique had a sudden increase in popularity, so that it is now considered, according to criteria of evidence-based medicine, the first-line treatment for an episode of acute respiratory failure in 4 pathologies (the Fabulous Four): COPD exacerbation, cardiogenic pulmonary edema, pulmonary infiltrates in immunocompromised patients, and in the weaning of extubated COPD patients. The so-called emerging applications are those for which the evidence has not achieved level A, mainly because the number or sample size of the published studies does not allow conclusive meta-analysis. These emerging applications are the post-surgical period, palliation of dyspnea, asthma attack, obesity hypoventilation syndrome, and to prevent extubation failure. Potentially "risky business" uses include for respiratory failure from pandemic diseases and ARDS, where probably the "secret" for success is early use. Healthcare is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly, if at all, so their clinical use remains limited and heterogeneous. The low rate of NIV use in some hospitals relates to lack of knowledge about or experience with NIV, insufficient confidence in the technique, lack of NIV equipment, and inadequate funding. But NIV use has been increasing around the world, thanks partly to improved technologies. The skill and confidence of clinicians in NIV have improved with time and experience, but NIV is and should remain a team effort, rather than the property of a single local "champion," because, overall, NIV is beautiful!

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Section: Asthmamentioning

confidence: 65%

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Nava

2013

Respir Care

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“…However, there was a more rapid improvement in the forced expiratory volume in the first second ( paring two pressure levels of noninvasive positive-pressure ventilation with oxygen therapy alone, a greater reduction in dyspnea and a greater increase in FEV 1 were reported for the group that received noninvasive ventilation. 36 Importantly, the patients in the latter two RCTs did not have severe exacerbation of asthma (none required endotracheal intubation). Overall, the quality and quantity of the evidence were low, and there were very few outcome events in any of the studies.…”

Section: Exacerbation Of Asthmamentioning

confidence: 97%

“…[34][35][36] One trial, which cited selection bias in patient enrolment leading to a small sample size (n = 35), found no differences in outcomes. 34 The second trial was a single-centre trial of 33 patients that used sham noninvasive ventilation in the control group.…”

Section: Exacerbation Of Asthmamentioning

confidence: 99%

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

Keenan¹,

Sinuff²,

Burns³

et al. 2011

Canadian Medical Association Journal

325

202

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“…1 Noninvasive ventilation (NIV) is commonly employed to reduce work of breathing and minimize respiratory discomfort in those patients whose exacerbations increase the work of breathing. [2][3][4][5] Many pa-tients requiring NIV may benefit from effective inhaled medication delivery. 6,7 Many factors influence the efficacy of aerosol delivery during NIV, such as ventilator type, ventilation mode, circuits, gas density, humidity, interfaces, aerosol generator type, particle size, aerosol generator position, and factors related to the patient (including type and severity of disease, respiratory pattern, and ability to tolerate a face mask).…”

Section: Introductionmentioning

confidence: 99%

Radioaerosol Pulmonary Deposition Using Mesh and Jet Nebulizers During Noninvasive Ventilation in Healthy Subjects

et al. 2015

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BACKGROUND:In vivo deposition studies of aerosol administration during noninvasive ventilation (NIV) are scarce in the literature. The aim of this study was to compare radioaerosol pulmonary index and radioaerosol mass balance in the different compartments (pulmonary and extrapulmonary) of radio-tagged aerosol administered using vibrating mesh nebulizers and conventional jet nebulizers during NIV. METHODS: This was a crossover clinical trial involving 10 healthy subjects (mean age of 33.7 ؎ 10.0 y) randomly assigned to both treatment arms of this study: group 1 (NIV ؉ vibrating mesh nebulizer, n ‫؍‬ 10) and group 2 (NIV ؉ jet nebulizer, n ‫؍‬ 10). All subjects inhaled 3 mL of technetium-99m diethylenetriaminepentaacetic acid (25 mCi) and 0.9% saline solution via vibrating mesh and jet nebulizers during NIV through a face mask secured with straps while receiving positive inspiratory and expiratory pressures of 12 and 5 cm H 2 O, respectively. Scintigraphy was performed to count radioaerosol particles deposited in the regions of interest to determine radioaerosol mass balance from the lungs, upper airways, stomach, nebulizer, ventilator circuit, inspiratory and expiratory filters, and mask as a percentage. RESULTS: Vibrating mesh nebulizers deposited 972,013 ؎ 214,459 counts versus jet nebulizer with 386,025 ؎ 130,363 counts (P ‫؍‬ .005). In a determination of mass balance, vibrating mesh nebulizers showed a higher deposition of inhaled radioaerosol compared with jet nebulizers (23.1 ؎ 5.8% vs 6.1 ؎ 2.5%, P ‫؍‬ .005) and a higher proportion of radioaerosol deposited into the lungs (5.5 ؎ 0.9% versus 1.5 ؎ 0.6%, respectively, P ‫؍‬ .005). The residual drug volume was lower with vibrating mesh nebulizers (5.1 ؎ 1.5%) compared with jet nebulizers (41.3 ؎ 4.2%, P ‫؍‬ .005). CONCLUSIONS: During NIV in healthy subjects, vibrating mesh nebulizers delivered > 2-fold more radiolabeled drug into the respiratory tract compared with conventional jet nebulizers. Additional studies are recommended in subjects with asthma, COPD, bronchiectasis, and cystic fibrosis to better understand differences in both aerosol delivery and response. (ClinicalTrials.gov registration NCT01889524.)

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A Prospective and Randomized Study for Improvement of Acute Asthma by Non-invasive Positive Pressure Ventilation (NPPV)

Abstract: Objective We hypothesized that non-invasive positive pressure ventilation (NPPV)

Cited by 90 publications

References 36 publications

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

Radioaerosol Pulmonary Deposition Using Mesh and Jet Nebulizers During Noninvasive Ventilation in Healthy Subjects

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